Vaccines: Science, Undone Science and Anti-Science

13 March 2017

Vaccination policy is in the news again, with One Nation leader Pauline Hanson’s comment on the ABC’s Insider’s program that “I think people have a right to investigate [the vaccination issue] themselves” generating a firestorm of criticism from both sides of politics, medical and public health associations, media outlets, bloggers and just about everyone who likes hearing their own voice.

But the violent reaction to her remark that individuals have the right to ask questions about vaccination and “make an informed decision”, and the branding of this as “anti-vaccination sentiments” when Hanson has publicly stated she had her own children vaccinated – surely not the behaviour one would expect from an ‘anti-vaxxer’ – is frankly quite disturbing.

Peter Doshi, assistant professor of pharmaceutical health services research in the School of Pharmacy at the University of Maryland, and an associate editor of the British Medical Journal – which is the fourth-ranked general medical journal in the world – wrote an editorial on medical journalism in relation to vaccination, which was published in the BMJ on February 7, 2017. I shall quote this editorial at length because it is unlikely to be read by most journalists or members of the public, which I think is an utter tragedy because it is one of the most thoughtful and intelligent pieces of writing I’ve ever read on the subject. I have hyperlinked to the references cited by Doshi in his editorial:

“Good journalism on this topic will require abandoning current practices of avoiding interviewing, understanding, and presenting critical voices out of fear that expressing any criticism amounts to presenting a ‘false balance’ that will result in health scares.

It does matter if the vast majority of doctors or scientists agree on something. But medical journalists should be among the first to realize that while evidence matters, so too do the legitimate concerns of patients. And if patients have concerns, doubts, or suspicions—for example, about the safety of vaccines, this does not mean they are “anti-vaccine.” Anti-vaccine positions certainly exist in the world, but approaches that label anybody and everybody who raises questions about the right headedness of current vaccine policies—myself included (9)—as “anti-vaccine” fail on several accounts.

Firstly, they fail to accurately characterize the nature of the concern. Many parents of children with developmental disorders who question the role of vaccines had their children vaccinated. Anti-vaccination is an ideology, and people who have their children vaccinated seem unlikely candidates for the title.

Secondly, they lump all vaccines together as if the decision about risks and benefits is the same irrespective of disease—polio, pertussis, smallpox, mumps, diphtheria, hepatitis B, influenza, varicella, HPV, Japanese encephalitis—or vaccine type—live attenuated, inactivated whole cell, split virus, high dose, low dose, adjuvanted, monovalent, polyvalent, etc. This seems about as intelligent as categorizing people into “pro-drug” and “anti-drug” camps depending on whether they have ever voiced concern over the potential side effects of any drug.

Thirdly, labeling people concerned about the safety of vaccines as “anti-vaccine” risks entrenching positions. The label (or its derogatory derivative “anti-vaxxer”) is a form of attack. It stigmatizes the mere act of even asking an open question about what is known and unknown about the safety of vaccines.

Fourthly, the label too quickly assumes that there are “two sides” to every question, and that the “two sides” are polar opposites. This ‘you’re either with us or against us’ thinking is unfit for medicine. Many parents who deliberate on decisions regarding their children’s health ultimately make decisions—such as to vaccinate or not vaccinate—with lingering uncertainty about whether they were right. When given a choice, some say yes to some vaccines and no to others. These parents are not zealots, they are decision makers navigating the gray, acting under conditions of uncertainty in perpetual flux.

And among those uncertainties are the known and unknown side effects that each vaccine carries. Contrary to the suggestion—generally implicit—that vaccines are risk free (and therefore why would anyone ever resist official recommendations), the reality is that officially sanctioned written medical information on vaccines is—just like drugs—filled with information about common, uncommon, and unconfirmed but possible harms.(10) (11)

Although MMR and autism have dominated journalistic coverage of this issue, and journalists have correctly characterized the scientific consensus that rejects any such link, most journalists have insufficiently acknowledged the fact that bodies such as the Institute of Medicine have “found convincing evidence of 14 health outcomes—including seizures, inflammation of the brain, and fainting—that can be caused by certain vaccines, although these outcomes occur rarely.”(12)

And for 135 other adverse events investigated, the committee concluded “the evidence was inadequate to accept or reject a causal relationship” with vaccines.

Medical journalists have an obligation to the truth. But journalists must also ensure that patients come first, which means a fresh approach to covering vaccines. It’s time to listen—seriously and respectfully—to patients’ concerns, not demonize them.”

The media and medical establishment’s reaction to Pauline Hanson’s comments is rife with each of the failings listed by Doshi, as well as by blanket assertions – such as that made by Stephen Duckett, former head of the Department of Health and currently Health Director of the Grattan Institute that “Vaccines are safe” – when, as Doshi points out, there are significant gaps in the evidence base on vaccine safety (‘undone science’) that make such categorical statements untenable.

The world’s most respected and independent network of medical researchers, Cochrane (formerly the Cochrane Collaboration) has a somewhat more circumspect point of view than Duckett.

In their 2012 review, Using the combined vaccine for protection of children against measles, mumps and rubella, the Cochrane team stated,

“The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate”

Or in laymen’s terms, ‘we just can’t tell how safe the MMR vaccine is because the data we need to do that aren’t available or aren’t reliable’; while their review Vaccines for preventing influenza in healthy children contained this alarming comment:

“reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies”.

Interestingly, the view of current Australian Medical Association president Dr Michael Gannon that “Vaccines [in order to be] approved… have to be safe” was not entirely shared by one of his predecessors, former AMA president Steve Hambleton. Back in 2014, Hambleton called for immediate cessation of a trial of community pharmacists providing flu vaccination on the following grounds:

“Pharmacies have no proven record that they are safe or appropriate locations for such a private and potentially risky [my emphasis] clinical procedure as vaccination… all medicines carry benefits and risks… Health practitioners who perform vaccinations must have specific training that includes how to make an assessment about the safety of the vaccine for a particular patient, and how to recognise and respond to adverse reactions.”

Hambleton went on to ask the following questions in relation to administration of flu vaccines in pharmacies:

“Where is the private area to seek consent?”

“Where is the private area where patients can wait after vaccination until it is confirmed that there is no immediate allergic reaction?

“Where is the private area where a resuscitation can occur if needed, until the ambulance arrives?”

Hambleton’s statements clearly indicate that, as a doctor, he does not believe that all vaccines are safe for all people under all circumstances, which seems to be the position taken by politicians and medical associations alike in reaction to Hanson’s comment; and furthermore that vaccination decisions should be made by individuals in consultation with their medical practitioner, after a full informed consent process, and taking into account the patient’s health history.

This actually sounds a lot like what Hanson said when she answered a radio journalist’s request to clarify her view on whether parents should vaccinate or not by saying that ‘many parents had approached her over the years with concerns about childhood vaccination, and she’d advised them to go and talk to their doctor.’

Hanson further stressed:

“I’m not saying to people don’t get your children vaccinated… I had my children vaccinated. I never told my children not to get their children vaccinated. All I’m saying is get your advice.”

And that, I presume, means getting and acting on advice that’s tailored to your or your child’s unique set of needs and risks, as Steve Hambleton stressed.

When we are told that we must not question vaccination – or indeed any medical practice – the issue has clearly left the arena of science and entered into a realm that more closely resembles religious fundamentalism.  The embargo on debate and questioning is dangerous and anti-science since the legitimate practice of science requires that even the most deeply-entrenched paradigms must be up for debate, examination and re-examination in the light of incoming data. In contrast, fundamentalism enforces strict conformity to a set of beliefs that are held by those in authority to be incontrovertible. Anyone who questions such dogma or even attempts to present contrary evidence is branded a heretic and ordered to recant.

To borrow a phrase from Peter Doshi, this kind of thinking is unfit for medicine. Let’s get the hysteria, the puerile name-calling and the dogma out of the vaccine safety debate and, as Doshi advises, take the concerns of parents and other affected citizens seriously. Branding someone an ‘antivaxxer’ because they have genuine concerns about any element of this medical practice is intellectually lazy and fundamentally anti-science.

And finally, a little light relief from the Monty Python team, since expressing concerns about vaccine safety has become the 21st century equivalent of saying ‘Jehovah’:

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